Acta orthopaedica Scandinavica
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients.
We included in a prospective, randomized study 68 patients aged 70 years or older, with displaced cervical hip fractures. The patients were randomized to internal fixation with hook-pins (36) or primary arthroplasty (32) (total or hemiarthroplasty due to their prefracture status) and followed for 2 years. Patients with rheumatoid arthritis, mental confusion and/or residence in an institution were excluded. ⋯ The mean 2-year cost for a patient with internal fixation was USD 21,000 and of one with primary arthroplasty USD 15,000. We conclude that primary arthroplasty is a cost-efficient treatment. Considering the very much higher failure rate after internal fixation--leading to increased suffering for these patients--primary arthroplasty stands out as the best method for displaced fractures of the femoral neck.
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Clinical Trial Controlled Clinical Trial
Effectiveness of the ROBODOC system in preventing intraoperative pulmonary embolism.
Intraoperative pulmonary embolism occurs not only during cemented but also during cementless total hip arthroplasty (THA). We determined whether the ROBODOC femoral milling system can reduce intraoperative pulmonary embolism, by using of transesophageal echocardiography and hemodynamic monitoring. ⋯ The incidence of severe embolic events was lower in group 1 than in group 2. Our findings suggest that the ROBODOC femoral milling system may reduce the risk of clinically significant pulmonary embolism during cementless THA.
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24 patients underwent bilateral hip replacement, using the SROM modular system (Depuy Johnson & Johnson, MA, USA) with the porous-coated sleeve in one hip and an HA-coated sleeve in the other. 20 patients were followed for at least 4 years with clinical and radiographic evaluations. We found no difference between the two sides as regards the time of disappearance of thigh pain and hip scores. ⋯ There were no differences in the serial bone-remodeling pattern around the proximal sleeve and measurement of wear volume between the two groups. In the short- to medium-term, our findings support the view that the hydroxyapatite-coated femoral stem has no advantages over those with porous coating.
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6 patients with symptomatic nonunion of midshaft clavicular fractures were treated by internal fixation with an intramedullary cancellous screw and autologous cancellous bone grafting. At follow-up after median 21 (12-72) months, all nonunions had healed. The Constant score was median 98 (57-100) points. 1 patient, with shortening of the clavicle, had poor function.